Why Is My Cholesterol Still High?

Medically Reviewed by James Beckerman, MD, FACC on May 24, 2024
3 min read

You eat clean, you exercise, and you even take meds for it, but your cholesterol is still too high. That might be because of sneaky culprits you don’t know about. Here are a few.

About 1 in every 200 adults in the U.S. has a condition called familial hypercholesterolemia (FH). It’s a genetic disorder you can get from either one or both of your parents that prevents your body from processing cholesterol the way it should.

If you have FH, you’ve had it since you were born. It means you started out with high LDL (the “bad” cholesterol) levels, and they continued to rise. You may not show symptoms until you’re an adult.

Because your body can’t get rid of cholesterol, it builds up in your arteries. This makes it harder for blood to flow and makes your arteries themselves stiffer. Over time, this leads to heart disease. In fact, people with FH have 20 times the risk of getting heart disease than those without it.

Cholesterol can also build up in other parts of your body when you have FH. It might show in these parts of your body:

  • Skin. Cholesterol deposits can make spots on your hands, elbows, and knees, or the skin around your eyes.
  • Tendons. Your Achilles tendon and some tendons in your hands can get thicker.
  • Eyes. You may get a white or gray ring around the colored part (iris) of your eye.

Although FH makes it harder to get your cholesterol under control, it can be treated. You may need more than one cholesterol medication, such as:

  • Statins, which block a substance the liver needs to make cholesterol.
  • Ezetimibe (Zetia), which reduces the amount of cholesterol you absorb from the food you eat.
  • PCSK9 inhibitors, which help the liver absorb more LDL cholesterol to get it out of your bloodstream.

Some people with severe FH may need to have special procedures periodically to filter excess cholesterol out of the blood. Some extreme cases may require a liver transplant.

You may think eating food labeled “cholesterol-free” is helping your heart. But it’s just as important to keep tabs on the amounts of saturated and trans fats in your food. Look at saturated fat, trans fat, and total calories in one serving. The American Heart Association recommends limiting saturated fat to less than 6% of your total daily calories.

To help do this, limit red or processed meat and whole milk dairy products and skip sugar- or sodium-filled foods and fried food. Choose those with fats and oils near the end of their ingredients lists, or better yet, stick to foods you know are in the healthy heart zone, such as:

Skim milk, low-fat or fat-free dairy products

  • Fruits
  • Vegetables
  • Whole grains
  • Poultry
  • Fish
  • Nuts
  • Nontropical vegetable oils

Take stock of your physical activity. Are you getting enough of the right kinds of healthy movement? Go for repetitive exercise that works more than one muscle group at a time and gets your heart pumping for at least 30 minutes 5-7 times a week. Going all-out, especially if your body isn’t used to it, could lead to injury, making it harder to get physical activity in over the long term.

Try these cholesterol-lowering exercises:

  • Brisk walks
  • Cycling
  • Swimming
  • Yoga

Check with your doctor to see if any of the meds you take -- for any health conditions -- could be causing a rise in your cholesterol levels. Some medications for asthma, rheumatoid arthritis, and connective-tissue disorders can raise your cholesterol. Acne medications called retinoids that have vitamin A in them may also cause your cholesterol to spike. Certain birth control medications with progestin may both lower your HDL (“good” cholesterol) and raise your LDL (“bad” cholesterol). 

And if you have a glass of grapefruit juice in the morning along with your cholesterol-lowering statins, you may need to choose another juice. Grapefruit juice has a chemical that can interfere with the enzymes that break down statins in your digestive system. Ask your doctor how much grapefruit is safe for you to have.

Cigarette smoke has thousands of chemicals that damage blood vessels and increase your cholesterol levels. One chemical called acrolein stops HDL from carrying cholesterol away from fatty deposits toward the liver. The liver is the place cholesterol is turned into waste so it can leave the body. When this process is disrupted, cholesterol can build up, leading to narrowing of your arteries (atherosclerosis).